Organization
OUT THA BOX FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE BERNADETTE AMBUSH LM, IMS (IMPARTATION STRATEGIST)
(443) 722-9488
Entity
Organization
Contact information
Practice address
3156 MOUNT ZION RD APT 305, STOCKBRIDGE, GA 30281-4179
(443) 722-9488
Mailing address
3156 MOUNT ZION RD APT 305, STOCKBRIDGE, GA 30281-4179
(443) 722-9488
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
10/26/2024
Last updated
10/26/2024
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